Controlled Substance Agreement Use Within a Family Medicine Clinic

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The objective of this study is to assess clinical and patient characteristics before and after the implementation of a controlled substance agreement at ARUP Family Medicine clinic. This study aims to determine the level of adherence to the guidelines post-implementation of a controlled substance agreement by patients seen at ARUP Primary Care Clinic and identify the characteristics of controlled substance medications before and after implementing a controlled substance agreement.


We conducted a single center, retrospective, cohort study collecting patient data over 12-month period pre-implementation and post-implementation of a controlled substance agreement (CSA) through electronic health record (EHR) chart review and abstraction. This retrospective chart review took place at ARUP Family Health Clinic, the study center. Descriptive statistics were used to describe sample characteristics. Odds ratios (ORs) were calculated with associated 95% CIs, and differences were considered significant if OR CIs did not include 1.0 and the associated P values were less than 0.05. 


Of the final sample, 87% of patients were not first started on non-controlled substance medications. Table 2 reports changes in the number of refills and PCP visits between the pre-and post-implementation periods. After CSA enrollment, an increased was observed in the number of refills (OR, 0.81; 95% CI, 0.54 – 1.21), and in primary care provider visits (OR, 0.84; 95% CI, 0.56 – 1.26).


The implementation of a schedule II to V controlled substance agreement improved the number of patient agreements singed (53%), the number refills made by the prescribers to appropriately manage the medications need of their patients, and significantly decreased the number of schedules II to V prescriptions written outside a mandatory 3-month office visit by showing an increased in the number of primary care providers visit post-implementation of a controlled substance agreement.


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Recommend0 recommendationsPublished in College of Pharmacy, Virtual Poster Session Spring 2021


  1. Nice work! Do you know if the clinic plans to keep the controlled substance agreement as it is going forward? I’m curious if your project affected their plans for it at all. Thanks!

    1. The clinic plans to revisit our guidelines for CSA use this summer and will utilize Elisabeth’s research in that discussion! Great work on this, Elisabeth!

  2. Hi Liz! What a great topic! These contracts seem to be positive on all fronts: drug use rates, med refills, and provider involvement. This topic and your research experience should be a great conversation piece for your interviews! I enjoyed the layout of your poster! Easy to grasp concepts and take-aways! Good work! Thank you for sharing your research experience!

    1. Thank you Trish! I definitely look forward to impressing them during interviews, it was a great learning experience!

  3. Elisabeth, such nice work and a nicely developed presentation of the work in your poster. I have a statistics question related to your conclusions. Are the differences you note statistically significant? If not, I’m assuming they are likely still clinically meaningful, would you agree? Are there other outcomes that might additionally document the positive impact of the CSA?

    1. Hi Dr. Keefe, Thank you!
      The differences that I noted where not statistically significant as you can see from the odds ratio ( they both include 1). Now, thinking back, one thing that I could have done differently is to include the Number Needed to Treat to determine if they are still clinically meaningful. So yes, I agree that there is a likelihood for it to be clinically meaningful. Other outcomes that might also document the positive impact of the CSA include urine drug screens, to detect potential for abuse, but this was not part of the CSA agreements at ARUP.

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